B6.

GIAo nuc
. vA oAo .
TAO

•
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TRUNG HOC
. PHO THONG

'

Ho. va ten hoc

. sinh
. . Y.. .......T.H..1.... ....I .H..l!dN.ct. . . .. . . . . ..... . . . . . .. . . . ...
. . . . . . . . . . . .. . N.Cr..U

s-· ~t ...... /THPT

o:......
 C()NG HOA Xr\ H()I CHU NGHIA Vl~T NAM
O(,c l~p - "fl! do - H,.mh phuc

HOC
•
BA•
" '> "
TRUNG HOC
•
PHO THONG
'.
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HQ~•a1eri·::~·>J~\\~7 1.11
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:···Tf1tt.d.ll~... . . . . . . . . .... . . .. . . . ......... .. . ... ..Gicn tinh:.........N.lf... .... .
Nga)· sinh:...AS. ~g:... r.l.cl...........nam........Jf{).5.. . ................................................. . .................................................
Noi sinh: --~llt-···.JTup.R...__:....Li... J::1..a).....~. . . Y.tn......~.u....D\l
. . _-_tci_Lfric;ing_ _ _ ......
Dan tQC................l\.n~. . . . .. . .... .-.. . . con li¢t si. con thucmg binh (~nh binh. ngucri dugc hubng
che do nhtr thtrcrng binh, gia dinh c6 cong vcn each mang) ...................................................................................
Chb iJ hi¢n tiµ: _Jil~Jl\!£. -=Jii t'JQJ__,_ )'@:.~12u'ii.~--=·· t iG . . ?ia'½J:;:···········
HQ va ten cha:.........N.~ ~···J1k.Il.. ..f2uLt . . . . . . . .. ... . . . ..... .Nghe nghi~p: ......f~m.....llll°:!l i. . . .
Ho vaten me: ......
• •
Il\.a.,i. . . JRI. . . Ju. . . . .. . . . . . . . . . . . . . . . . . . ... Nghe nghiep:...l o.n1.. . ./w.6110 ...........
• '""' "-1 • • ·~

Ho va ten ngtroi eiam.hO: ....-..··-·································································Nghe nghiep:..................................·-···················

• to.,,; '-' • ~ •

.~. ~J-···· ngay ....9......~.thang.~ ......niim 202.0......

HIEUTRU'ONG
/<:_::.
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g;:_ 6h9 ten va dong d,fuJ
/ -,ll -:'IQ
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~ KT.HIEU TRUONG
PHO HiEU TRVONG
QUA TRINH HQC T~ ?ow1i Van Jlinl.
Tin tnmng, huy;n (qu~n. th! xa, .,
Xac nhan cua
Nim h9c Lap
TP thu{>c tinh), tinh (TP)

20.,:W. - 20.J.-J. tiOAt T+lPT 'kn D~ 5;6',/- Yin Pahg - Ber

20 ...... -20......
I • 'I
,20...... -20......

1
H<;, va ten..............N~.t~L}•··. :.W.,t. . .] ~ufd.ll~............. Lap.....AOJ\.t ... Nam h<;,c,20..r.l0::.; ..-20...r2.d.. ...
.D. . . . . .. . . . . . .. . . . . . . . .. . . . . . . . . . . . .Cac 1n61& h9c nling cao:.... Jcr..1..tl ...1.....Yclo..,...:lln~......
Ban..................
Olirn
Ml>n hQC/ Olim trung blnh ho.c x · Gl6o V16n ~ m6n ky uc
h t dA x6'p IOfl de m6n .._1aau nhtn OTB m6n h9C h~c
°'Gov"U l - -- - - - - . - - - - - - - - , - - - - ---1 lal xlp IOfl ilia chfla (na1co).
(naJci>) (K5' vs ghl r6 hQ 16n)
KT v•
Hky I Hky II CN
Toan
V~t Ii

~ Si~nh~h~<?C:.j__ __.!f,~,g~ _ _J_~ T.7J/~6_ _ L_..Icl_2__ _j__ _j_~ :illJMrmlNh0A~'~,.

Tin hQC

Nguvan 11 o

E>iem

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DC N~n
xet
»·1furt, tr Mi .':/l:fJQIJ1:(! lri/,. >vh--=
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C6ng ngh~

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OTB JtJ _! _
cac m6n O
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Trong bang nay c6 slta chfta o: .. ~........chO, thu(>c cac mOn hQC: .......................................... ..
........... ·• ······..·······························································
X6c nhtn CUI gl6o viin chu'nhl9m
(Kj va ghi ro h<J ten)
.

2
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K6't qua Xl'p lo~II sau KT 1,1 - Oll<Jc len lop thang:
HQC
KY
x6'p 10,1 TS bu61
nghlh9c
canlm
c6c m6n h9c hofc
ren luytn them HK v, ... ... . . .~. .uf.dd...................... ...........
Hl HK - Ollge len lop sau KT l~i mon h<;>c
Hl HK
ho~c ren luy~n them ve HK:
H<;>e ky I
Ct 0
Hoc ky II Q- f 0 - Khong du'c;,c 16n lap: ........................

Canam ·Ct- . r n
- C0, Ch•'""'
u,,g Ch'I NQh eA. p h,:,
O thong:................................................................ Lo,,11:
. ............................................ ..

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1trl.
Qli:11 uvng t rong cac
, ky• th.I t(t• I.A:lp
_ ,I{ h
uy~n t rO• Ien: ........................................._. .................................
A A • • •

'· ·························································.. ···························································································································

'
- Kh en th llOng ~x b·:i..t.kh'
. '\It:. ac:...............................................................................................:...............................
uaC

.. . . . . . . ... . .. . . . . . ... . . . ... . .. . .w.n.~.J.a..~..c&iw...........................................................................

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. ·.·.. . . XET CUA GIAO VIEN CHU NHIEM

NHAN .
(Ky va ghi ro h9 ten)

~~~rv , ~~_,e-n~ ra u~ M·
1wJ, cltj; d 7 ,Jli.w >u-m ft.a~

e,;,t ~1 ~- I Gre,-1

PHE DUY~T CUA H1eu TRlJONG

. 1p,. .PM , J .... , ngay...25.....th?ng...G......niim 20.V .....

KT.HIEU TRVC1NG
PHO HiEU TRUONG -
wuin,1/an ultm/,
3
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Ho l'CJ ten :.. ...NC.Lttl ... . \l .. ...D1J(d l\.O........... Lcip:..~HA1 .... Nam h9c 20.o2.::1......-20...o2.o2.. .. .
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Ban: ... ... J) . ................ .. .... ................................... Ccic mon lu;,c 11dng cao: ..... .O.OO. ...,.....V.f41... ,. ... Anl&...
I
I Mon hQc/
,
h~c xe
Diem trung blnh ho~c I oven bQ mon ky xac
o1&n G'a 1· • •
h~t dQng xe·p lo{II cac mon
loal sau ~-h~n OTB '!'on h9c ho~c
I GD f - - - - - - - ~ - - - - - - , - - - - - - 1 KT lal xep 10,1. v~ s~ chua (n~ c6),
Hky I Hky II CN
(neu cil) (Ky VB gh1 rO h() l~n)

Toan
V~t Ii
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H6a h<;>c G,
Sinh h9c
t,4-
Tin h9c
NgfrV~n
f r
Ljch SU'
0jali
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QP-.0
0iem
1, J I RUd

GDC Nh?n
rJ ujc Jet- ../
Tuf ttfc JU ~
4. 11il .,.........-- _Y·!
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xet /I#° ~/11· :J{.t«Jn, -

Cong ngh~ q,o

GD QP-AN 1,6
The dl:IC -I)
NN2
Tl/ Nghe
ch9n PT f, I-

Trang bang nay c6 sU'a chl/a a: . .~.....:. .cho, thu9c cac man h9c: ............................................
····························································································································•.···················································
Xac nh~n cua giao vien chu nhi,m
(Ky va ghi ro '19 ten)

4
Trrtitng:] Hn ..Y
in0/d/J.i I
H,,yf11 (TP):...... . ..Yin . a~ · · · ···· Ti11h:.......&d;. . .,focwg, .
Ket qua Xep lo~I sau KT l~I . Ol/C1c len IC1p thang:
HOC TS bu61
xep lo~i cac mon h9c ho~c · ,· ..L ,
KY ngh, h9c ren luy9n them HK ve ..............~..J~f···•--•i•M~19--...~......... .
r-------r--
HL ~ ca n~m r --
HK --.--- - 7
- Ouc;,c len lap sau KT l~i mon hqc
HL HK
r-- - i - - - - - t - --+-- - - + - - ----11---- - ~ ho~c ren luy~n them ve HK:
H9cky I ~ r
H<;>c ky II . .JI'\ i - Khong dl/<;Jc len lap:........................
Can~m lt- r
. ., -
-C6 chung chi Nghe ph6 thong:....J.i.t1......hq.c....Y.an.... pho119............... Lo~i: ..........~1.0.1.. ..........................
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- OL!Qc giai thLtang trong cac ky thi bi cap huy~n tro len:............................................. ,............................ .
. ......................... ..·········. .······.............~ill. ...~ .k.......P.n.1.l....C?..rrf'..... ~~<"'. . . . . ... . . . . . . . . :... .. . . . .... . . . . ..
- Khen thLtang d~c biet khac:............................................................................................................................. ..
. ........................ .......·. ~. . ~. . . .............&i: . . . Jf(c-tr.,:........................................................_. .....;·····.. ·.... ·.......................
······················································································································································································

NHAN XET CUA GIAO VIEN CHU NHleM

. (Ky va ghi r6 h9 ten)

Vrerl
/,&13~ 0£ ~~ ~

PHE ouver CUA H1eu TRlJCJNG

l lPxl.... ~~... ,ngay.....t.... ..thang....k.. . niim 2022....
q ··· <J - Hieu truong
,J;!f1t:.W:::ti.t!!l... • va dong dcfo)

. ~ :
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.s' CJ~ .· KT.HI EU TRUONG
* · PHO HiEu TRUONG
?win Vwnultml,
H9 va ten.: ....... . N.g.~J. .
..1fi. . ..Ifu.ia,.~ . . . . .Lap:..1l..A..t. ... Nam h9c 2f.J.:b.......: 20......t.3. .
Ban: . ..............]) ................................. .................. ........... Ccic mdn. h9c niing cao: ....... ]00!1. .....1.... .1. . . A.nf.-v ran.. .
E>l6rn • • •
Mon hQc/ E>him trung blnh ho~c h-"' -:.., Glao vlen h9 mon ky xac
, uaC xet' h. E>TB •
ho~t dQng xep lo~I cac mon 1~ 1sau ~- ~n . . '!lon ~Qc ho~c
1--- - - -~ - - - - ~- - -- - -; KT
GD
Hky I Hky II CN
(neu !)
1 1 xep lo~• va sl/a chl/a (neu c6),
(Ky va ghi ro h9 ten)

Toan
V~t Ii
H6a h9c
Sinh h9c
Tin h9c x, 6 t>t
NgLIV~n
L!ch s11 g,g
O!a If 't t
.~i~~-~. 9/f
E)iem ~I ,b

GoeD Nh~n r.rrt~

JJ '
W~ r('.l
xet
T~ Wt KT " r .0
( L·v) Utt rC/

Cong ngh~ :1.r

GD QP-AN g,o
Th~ dt,Jc ,J) ·D -D
NN2
Tl,INghe
ch9n ~ PT.!-.+- - - - --1-- - - --+-- - - ---l- --l--- -- - -- --l

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cac m6n . ~
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3, b ll~ l\~~1~~f, ·H',,' lrd ,
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Xac nhtn cua glao vl6n chu nhlfm

(Ky w> ~lti ni It(>1f 11)

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Trui1ng:.T HPT.YiiJ~ ..i .Huy¢n (TP): ...............Yt.4 .... 0.u.~..... . .. Tinh: .... ....&.di.. ... fri.~
Kt't qui Xip lofl sau KT 191 - 0llc;,c Ian lop thang:
TS bu61 c6c m(,n h9c hofc
HQC
KY
xt'p 10,1
nghlh9c ran luy♦n th6m v6 HK . . . . ...,D.d....~.J~.... ttf............ ......
ca nAm - 0llc;,c Ian lop sau KT lc;1i man hc;,c
HL HK HL HK
ho~c ren luy~n them ve HK:
HQC ky I ~ T ~
HQC ky II Cr 1 0 - Khong dllc;,c len lop:........................

Ca n~m v- T 0
- C6 chung chi Nghe ph6 thong:............................................. ................... Loc;ii:............................................. .
- 0l!<;1C giai thl!ang trong cac ky thi W c~p huy~n tra len:......... ~\.J.~. . . t..t........ ~L.~..................
····································································· .. ················· .................................)11..~ .... J...~ ...:...........................
- Khen thl!ang d~c bi~t khac: ...............................................................................................................................
.....................................................ft:a-.f....lc.t~r....h:a.~....~.~b................... ..................... ....................................
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NH~N XET CUA GIAO Vl~N CHU NHl~M

(Ky va ghi r6 h9 ten)

htgban; Ii" fl.R.f ~ tti4J CD ) ~; ~mJ ~ &v;z k -

f~ ~C, -Pt.De --~ lt(l 'Le~{, {uLJen '

, Ctye.,f\/ ,

l~ J\(9i«g-e~ Je1.l
(
Jea:;

PH~ ouver CUA H1eu TRl/ONG

"' ..,.,
yen.. DJJtQ, ngay.............. thang.. .£,.....nam 20)l3...
(/ Hi~u trmmg
(K OJU.-~r,q,_ va dong ddu)
/

.Hl !;U TRV0!'1G

HO HIEU TRUON G
1M,i ✓r;ifm, u11i,J,